Eating Disorders Treatment: Evidence-based or Opinion-based?
Good Question...Complicated Answer
As a big fan of evidence-based treatment of illness, the first question I get is "what does that MEAN?"
I find that defining "evidence-based" is more about what it is NOT. It is not opinion.
We assume this with drug treatments, for example. We assume any drug our pharmacist packages up for us has been tested for efficacy and for safety. We assume it has been compared with other drugs. We would be shocked if the medicine prescribed on a hunch, because the doctor had tried it before on people and they'd felt better, or because it seemed like it should work. Any doctor who prescribed, or pharmacist who bottled, an untested treatment would be subject to legal action.
Psychological treatments, and treatment of psychological symptoms, don't operate under the same standard. Most have not been compared to others in equal trials. Most are not evaluated for safety. There are no enforceable rules for when to prescribe what, and no banned treatments. Opinion-based treatment can have its genesis in anything from university training to ideas formed in dreams.
Dehumanizing and mechanistic
Many people object to the idea of having psychological symptoms treated by rules or guidelines. Some believe the idea of "evidence-based" practice is dehumanizing and mechanistic. I understand this and actually sympathize: the idea of evidence-based practice can go too far. In a field where so little has been researched, we cannot stake certainty on the bits we know.
A wonderful recent piece in the Eating Disorders Review, available online, gives an overview of the gap between research and practice in the eating disorder world - with a bit of context about the larger mental illness treatment world.
Why am I so big on evidence-based practice? The obvious answer would be because they are more likely to be effective. But the larger truth is that there are so many sincere but unhelpful, and even actively harmful treatments out there and no way for families to know the difference. Knowing who to trust can't be a matter of what sounds best or easiest or fits into our lifestyle. It needs to be based on evidence, and not opinion - this is too important an issue.
Collins, L. (2010, July 14). Eating Disorders Treatment: Evidence-based or Opinion-based?, HealthyPlace. Retrieved on 2024, February 22 from https://www.healthyplace.com/blogs/eatingdisorderrecovery/2010/07/eating-disorders-recovery-evidence-based-or-opinion-based
Author: Laura Collins
Right, Laura! When our loved-ones' lives are at stake, we want a treatment that controlled studies show works better than other available options. People expect that with their drug, surgical and other treatments, and we should expect no less for mental illness.
Um, this isn't true.
All drugs pass are tested for safety and efficacy. You can't get FDA approval if you don't. All drug trials (psychopharmacological and otherwise) are strictly controlled and done in phases. Drugs must all be better than placebo to get approval. Moreover, many drugs, if not all, are tested against other drugs of the same class.
"Phase III studies are randomized controlled multicenter trials on large patient groups (300–3,000 or more depending upon the disease/medical condition studied) and are aimed at being the definitive assessment of how effective the drug is, in comparison with current 'gold standard' treatment."
And in phases I and II there is additional data. The drug has to be in or passed stage III to get FDA approval.
Yes, it's true that drugs are prescribed off label. But they have to be. If they weren't, a huge percentage of people wouldn't get better. I certainly agree that proven treatments should be tried first, and normally they are, but when those fail, other options have to be available.
And to the best of my knowledge, any doctor can prescribe any drug for any reason, not just psychopharmacological ones.
And yes, for this reason you do have to have a doctor that you trust. But then, that always needs to be the case.